Introduction to the Rabies Blueprint

Global Alliance for Rabies Control

World Rabies Day

Partners for Rabies Prevention

Burden of rabies HE of rabies

2007

2008

2010 2011-2014

Rabiesblueprint.org

2013-2015

www.RabiesBlueprint.org

The rabies surveillance blueprint

A new information and learning module

Thomas Müller

Pan African Rabies Control Network

Tuesday 9 June: Afternoon session Day 1

Pan African Rabies Control Network

A Users Guide to The Blueprint for Canine Rabies Control

Louise Taylor, GARC

PARACON, June 7-9, Gauteng, South Africa

www.RabiesBlueprint.org

CanineRabiesBlueprint.org

• Third version - fully revised and completed September 2014 • English and French online now, Spanish to follow (thanks to all our translators and especially Jacques Barrat)

Overview of the Site CANINE RABIES BLUEPRINT PAGES 1. Introduction 9 2. Roles and Responsibilities 2 3. Infrastructure, legislative framework, costs and funding 3.1. Infrastructure 11 3.2. Legislation 15 3.3. Costs and Funding 7 4. Communications plan 4.1. Importance of an effective communication plan 1 4.2. Developing a communication plan 8 4.3. Evaluating the campaign and its impact 4 5. Operational activities 5.1. What do we need to know before we start planning a programme? 17 5.2. What do we need to buy? 6 5.3. Who do we need to train and in what? 4 5.4. What are we going to do – dog component? 20 5.5. What are we going to do – human component? 6 5.6 Evaluation 5 5.7. How do we ensure sustainability of the programme? 1 6. A stepwise approach to planning and evaluation 10 LINKS Case studies 22 Documents 112

Navigation

Searching and by component

Example of a regular page

From the Communications section

Example of a documents page

A Case Study

Another Case Study

Tools for Advocacy

Plans for the future

• Include all relevant resources for canine rabies control and update as necessary

• Link to the Rabies Educator certificate and other educational resources

• Incorporate feedback from meeting such as this

• Document how it has supported country efforts

Thanks to • All the contributors of the information,

documents and case studies in the Blueprint. • To all of our translators and Translators without

Borders, and Jacques Barrat for proofreading • You for your attention! We welcome feedback:

Blueprint@rabiesalliance.org

The rabies surveillance blueprint

A new information and learning module

Thomas Müller Conrad Freuling

PARACON, Glenburg, South Africa, 9-11 June 2015

Rabies Surveillance Key link

Small no. of cases

Lack of incentive Poor

surveillance

Lack of funding

Data-driven assessment

Estimate of true incidence

Policy decisions

Impact of interventions

Cost-benefit and other studies

No effective control and elimination

RABIES ELIMINATION PROGRAMME

CIRCLE OF NEGLECT

“make good decisions with limited data”

Rabies Surveillance The art here is to …

Probability of detection = a function of prevalence, level of awareness & vigilance

Rabies Notifiability Survey 2011

Green = Yes, Red = No, Grey = no data (Taylor et al. 2014)

Rabies Notifiability Survey Human rabies

Red = Not notifiable, Green = effective, Orange = Ineffective, Grey = no data

Effectiveness of Rabies Surveillance Human rabies

very heterogeneous across the world

High degree of ineffectiveness

(regions where burden is highest)

Notifiability does not mean an

effective surveillance is in place;

it is only the first step to implement it

Huge differences in quantitative &

qualitative rabies surveillance data

Human and Animal Rabies Surveillance Current status

Terrestrial Animal Health Code (2014) - Animal health surveillance

Global infectious disease surveillance

WHO Expert Consultation on Rabies 2013

Risk-based disease surveillance

Task Force on Animal Disease Surveillance

Disease Surveillance Definitions & guidelines (pros)

Scientist and responsible authorities often do not speak the same “language” too generalized, “scientific”, abstract

people across the world often have different perceptions on the issue

different states of knowledge, and sometimes even misconceptions

no detailed rabies tailored approach covering both human and animal related aspects yet

Disease Surveillance Definitions & guidelines (cons)

Global Rabies Surveillance Current obstacles

different definitions & focus

different approaches

different responsibilities

regionally biased

different levels of rabies diagnosis

numerous reporting systems

missing/different national databases

different international databases

Global Rabies Surveillance Do you as an expert know…

what rabies surveillance actually means?

the components rabies surveillance comprises of?

what is required to make rabies surveillance adequate and efficient?

if surveillance is the same as monitoring?

which form of surveillance is best suited for rabies?

who is responsible for implementation?

what you can do to make the system work?

The Rabies Surveillance Blueprint A new information and learning module

Divided into six main sections Introduction

Rabies surveillance

Minimum requirements for adequate rabies surveillance

Laboratory rabies diagnosis

Epidemiological analysis

Reporting, dissemination and communication

The Rabies Surveillance Blueprint A new information and learning module

The Rabies Surveillance Blueprint Answers to 78 questions

The Rabies Surveillance Blueprint Answers to 78 questions

brings together relevant information from specific international health organizations

published data from the field

expert knowledge

not meant to replace existing material or guidelines

meant to serve as an easy to use guide

The Rabies Surveillance Blueprint A new information and learning module

The Rabies Surveillance Blueprint A new information and learning module

clear and concise key messages

In English and French

endorsed by WHO

links to specific documents and websites for more information if so required

regular updates by PRP experts

new or modified recommendations can be immediately included

The Rabies Surveillance Blueprint Further ideas

refinement of document

incorporating approved SOP for standard laboratory techniques in rabies diagnosis

implement link to “RISKSUR”

provision of exemplary organizational flow charts as templates for countries in need in Africa or Asia by giving them ideas how other countries in the world implemented structures, work flows and chain of commands to make rabies surveillance efficient

The Rabies Surveillance Blueprint Lessons learnt

Dealing with rabies is not the be-all and end-all

Even a rabies expert can learn a lot about surveillance!

The Rabies Surveillance Blueprint Acknowledgements

Dennis Slate Conrad Freuling, Tiziana Lembo Louise Taylor, Lea Knopf Hervé Bourhy, Charles Rupprecht

Thank you! Merci beaucoup!

Preventing human rabies: messaging and measuring

• Highest fatality rate of all infectious diseases Preventable, not treatable

• Children < 10yrs most affected

Need to measure animal and human rabies burden:

• Under - estimate economic and human health impact • Justify need for and costs of ‘Post Exposure

Prophylaxis’ • Encourage dog vaccination and make a case for

elimination of dog rabies

How?

• Rabies DALYS versus other • Epidemiological models: Estimated 75 000

deaths/year-Africa and Asia Hampson, Knobel et al MMWR

• Animal bite registers • Quantity of rabies vaccine and RIG used

Surveillance: Clinical surveillance: misdiagnosis Laboratory confirmation: access to tissue samples difficult, limited human rabies diagnostic facilities

Rabies Blueprint. com GARC

Rabies must be part of differential diagnosis in every case of encephalitis

Anderson, 29, who was also a top canoeist, died last week after machines keeping him alive were switched off. He spent five weeks in the ICU at a Pietermaritzburg hospital before his death

13 June 2012

Rabies stories that capture the headlines

56 year old SA factory manager: ex Luanda, Angola

• Presented with fever, headache and weakness • Admitted to JHB hospital with confusion and

hallucinations – seen by 2 specialist neurologists – diagnosis of encephalitis ……. Investigations++++ but not for rabies

• Pre- travel consultation: yellow fever vaccination only

EID

Outbreak of rabies, South Africa Limpopo 2005 - 31 human cases Initial physician diagnosis: cerebral malaria, polio, meningitis, typhoid

EID 2007

28 year old Mpumalanga man

• Headache, fever, confusion, hydrophobia, bilateral weakness of limbs, depressed level of consciousness – ? Rabies

• Sustained injury when intervened in fight between own dog (rabies unvaccinated) dog) and stray dog on farm previous December

• Cat scan, CSF – normal; repeated rabies tests neg (saliva, CSF, nuchal biopsy)

5 year old child, E Cape

• Admitted to hospital: depressed level of consciousness and hypersalivation

• Scar on limb • Rabies negative on saliva

South East African Rabies Group (SEARG)

Mozambique 2011

• Human rabies cases under – recognised/notified • Very access to PEP • Laboratory confirmation rare – diagnostic tests

not available

HUMAN RABIES IS A NEGLECTED DISEASE

Rabies is a priority disease

• Country data essential • Rabies must be notifiable • Surveillance • Confirmed and probable case reporting • Diagnostic sample type- ‘thinking out the box’ • Access to laboratory diagnostics

Saving lives - Post Exposure Prophylaxis

• Intradermal vaccine: reduces costs and increases accessibility…… need to use vial within 8 hours, intradermal technique skills Hampson Plos 2011

• “Post-exposure Treatment of Rabies Infection: Can it be done without immunoglobulin?” Wilde CID 2005

• NB: Wound care

Teenager fights for life after rabies kills boy…. Daily Dispatch, 1st July 2005

• EAST LONDON - Rabies vaccine has been withdrawn and sent for tests after a Transkei teenager died of rabies and at least one more is seriously ill despite being vaccinated.

• "Rabies is a very dangerous disease, but once you have been vaccinated you are not supposed to get it, maybe something is wrong with the vaccine " said Health MEC

World Rabies Day Sept 2011 South Africa Source: Dr Kegakilwe, Veterinary Services Northern Cape

ONE HEALTH